Keeping the baby but not the bathwater

The reconstituted immune system of an allogeneic hematopoietic cell transplant patient is responsible for preventing leukemia relapse by means of graft-versus-leukemia (GvL) activity. This same reconstituted immune system can turn on the recipient in the form of graft-versus-host disease (GvHD). Tugues et al. used multiple mouse transplant models to decipher the mechanisms driving GvHD and GvL. They discovered that GM-CSF–activated myeloid cells mediated GvHD, but did not contribute to GvL, which is largely carried out by T cells. These results suggest that blocking GM-CSF in hematopoietic cell transplant recipients may be able to specifically target cells that promote GvHD, without hampering those that enact GvL.

Abstract

Allogeneic hematopoietic cell transplantation (allo-HCT) not only is an effective treatment for several hematologic malignancies but can also result in potentially life-threatening graft-versus-host disease (GvHD). GvHD is caused by T cells within the allograft attacking nonmalignant host tissues; however, these same T cells mediate the therapeutic graft-versus-leukemia (GvL) response. Thus, there is an urgent need to understand how to mechanistically uncouple GvL from GvHD. Using preclinical models of full and partial MHC-mismatched HCT, we here show that the granulocyte-macrophage colony-stimulating factor (GM-CSF) produced by allogeneic T cells distinguishes between the two processes. GM-CSF drives GvHD pathology by licensing donor-derived phagocytes to produce inflammatory mediators such as interleukin-1β and reactive oxygen species. In contrast, GM-CSF did not affect allogeneic T cells or their capacity to eliminate leukemic cells, retaining undiminished GvL responses. Last, tissue biopsies and peripheral blood mononuclear cells from patients with grade IV GvHD showed an elevation of GM-CSF–producing T cells, suggesting that GM-CSF neutralization has translational potential in allo-HCT.